SAMHSA Head Stands Firm on Marijuana's Dangers

Also says younger generation of providers is key to opioid fight

FORT WASHINGTON, Md. -- A top health official in the Trump administration, speaking at a behavioral health conference on Monday, pushed back on states' efforts to legalize marijuana, asserting it's a dangerous drug that should be kept out of the public's hands.

Elinore McCance-Katz, MD, PhD, the Assistant Secretary for Mental Health and Substance Use -- and thus overseeing the Substance Abuse and Mental Health Services Administration (SAMHSA) -- raised concerns over the increased use of marijuana in the U.S., particularly among children, adolescents, and pregnant women.

"For too many years, we have simply heard a message from an industry that makes... billions of dollars ... about how safe this drug is. I'm here to tell you this is not a safe drug," McCance-Katz said during a town hall event at "NatCon18," the National Council for Behavioral Health's annual conference.

"Americans have a right to know that and we should be telling them that," she continued.

Thirty states and the District of Columbia currently have laws that legalize marijuana in some form, according to Governing magazine.

McCance-Katz said the greatest number of "new initiates" to marijuana use are teenagers, which is especially concerning because their brains have not yet fully developed.

She cited numerous association studies linking marijuana use to a host of adverse outcomes: behavioral problems, early-onset psychosis, poor school performance, and low birthweight deliveries, among others, although those studies could not determine a cause-and-effect relationship.

And while tobacco and alcohol rates have declined among pregnant women in recent years, illicit drugs -- mainly marijuana but also opioids -- have increased from 78,000 women in 2015 to 111,000 in 2016, she said.

McCance-Katz sought to counter recent news reports that suggest marijuana legalization may have driven down use of opioids.

On the contrary, "marijuana use was associated with substantially increased risk of addiction and overdose for opioids," she said, citing research from Mark Olfson, MD, MPH, and colleagues in the American Journal of Psychiatry.

Opioid Issues

McCance-Katz also warned of a relatively new drug product known as "speedball." In the past, speedball was typically a blend of heroin and cocaine, but a more deadly variation consisting of fentanyl-laced cocaine is killing people with addiction issues in the New England states, she said.

In 2017, 7% of the cocaine seized across New England contained fentanyl, she said.

Individuals who use cocaine but have not developed a tolerance to opioids have a high risk of overdose and are "likely to die," she said.

McCance-Katz also spoke about efforts to increase access to medication assisted treatment (MAT) and her faith that the next generation of providers can see past the stigma of substance use disorders.

During a question and answer session that followed her talk, McCance-Katz was asked when SAMHSA plans to raise the cap on the number of patients that providers authorized to administer medication assisted treatment (MAT) can treat.

Prior to joining SAMHSA, McCance-Katz was a professor at Brown University in Rhode Island where she designed training programs for physicians on treating opioid use disorder.

"The idea here is that we train a new generation that doesn't have the same stigma associated with substance use disorders, because they're seeing it in primary care, they're seeing it in emergency medicine and they're learning to deal with it," she said. "They're learning Screening, Brief Intervention and Referral to Treatment (SBIRT). That's our key."

Audience members also asked about sharing of patient medical information under 42 CFR Part 2, a federal law which offers some privacy protections to those seeking substance use disorder treatment.

During the session, McCance-Katz noted that drug overdoses are not included under the 42 CFR law, and that it is "not a violation" under such circumstances to contact family members.

In some cases, even when patients have waived certain privacy rights, the law still sometimes hinders communication and providers' ability to practice collaborative care, said one NATCON18 participant who urged loosening such provisions.

SAMHSA has gone as far as it can within the current law to relax 42 CFR including publishing guidance to clarify any of the nuances of the law, McCance-Katz told MedPage Today after the event.

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